Mercer Mary P, Mahadevan Swaminatha V, Pirrotta Elizabeth, Ramana Rao G V, Sistla Sreeram, Nampelly Bhanuprasad, Danthala Rajini, Strehlow Anne N T, Strehlow Matthew C
Department of Emergency Medicine, University of California San Francisco, San Francisco, California.
Division of Emergency Medicine, Stanford University School of Medicine, Stanford, California.
J Emerg Med. 2015 Oct;49(4):448-54. doi: 10.1016/j.jemermed.2015.02.041. Epub 2015 May 23.
Shortness of breath is a frequent reason for patients to request prehospital emergency medical services and is a symptom of many life-threatening conditions. To date, there is limited information on the epidemiology of, and outcomes of patients seeking emergency medical services for, shortness of breath in India.
This study describes the characteristics and outcomes of patients with a chief complaint of shortness of breath transported by a public ambulance service in the state of Andhra Pradesh, India.
This prospective, observational study enrolled patients with a chief complaint of shortness of breath during twenty-eight, 12-h periods. Demographic and clinical data were collected from emergency medical technicians using a standardized questionnaire. Follow-up information was collected at 48-72 h and 30 days.
Six hundred and fifty patients were enrolled during the study period. The majority of patients were male (63%), from rural communities (66%), and of lower socioeconomic status (78%). Prehospital interventions utilized included oxygen (76%), physician consultation (40%), i.v. placement (15%), nebulized medications (13%), cardiopulmonary resuscitation (5%), and bag-mask ventilation (4%). Mortality ratios before hospital arrival, at 48-72 h, and 30 days were 12%, 27%, and 35%, respectively. Forty-six percent of patients were confirmed to have survived to 30 days. Predictors of death before hospital arrival were symptoms of chest pain (16% vs. 12%; p < 0.05) recent symptoms of upper respiratory infection (7.5% vs. 4%; p < 0.05), history of heart disease (14% vs. 7%; p < 0.05), and prehospital hypotension, defined as systolic blood pressure <90 mm Hg (6.3% vs. 3.7%; p < 0.05).
Among individuals seeking prehospital emergency medical services in India, the chief complaint of shortness of breath is associated with a substantial early and late mortality, which may be in part due to the underutilization of prehospital interventions.
呼吸急促是患者请求院前紧急医疗服务的常见原因，也是许多危及生命状况的症状。迄今为止，关于印度因呼吸急促寻求紧急医疗服务患者的流行病学及转归的信息有限。
本研究描述了印度安得拉邦由公共救护车服务转运的以呼吸急促为主诉的患者的特征及转归。
这项前瞻性观察性研究纳入了在28个12小时时间段内以呼吸急促为主诉的患者。使用标准化问卷从急救医疗技术人员处收集人口统计学和临床数据。在48 - 72小时和30天时收集随访信息。
研究期间共纳入650例患者。大多数患者为男性（63%），来自农村社区（66%），社会经济地位较低（78%）。院前采取的干预措施包括吸氧（76%）、医生会诊（40%）、静脉置管（15%）、雾化用药（13%）、心肺复苏（5%）和面罩通气（4%）。入院前、48 - 72小时和30天的死亡率分别为12%、27%和35%。46%的患者被证实存活至30天。入院前死亡的预测因素为胸痛症状（16%对12%；p<0.05）、近期上呼吸道感染症状（7.5%对4%；p<0.05）、心脏病史（14%对7%；p<0.05）以及院前低血压（定义为收缩压<90 mmHg，6.3%对3.7%；p<0.05）。
在印度寻求院前紧急医疗服务的人群中，呼吸急促这一主要诉求与较高的早期和晚期死亡率相关，这可能部分归因于院前干预措施利用不足。
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